Table 70-13 Suggested referral criteria for sex reassignment surgery (SRS) after minimum Standards of Care for eligibility and readiness have been met
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Factors supportive of referral: Patient and psychiatrist have followed the Harry Benjamin International Gender Dysphoria Association (HBIGDA) current Standards of Care (Levine et al. 1998; revision likely in late 2001) Long-standing gender identity disorder Successful societal adaptation in gender role (social, familial, occupational) Lack of or well-controlled psychiatric comorbid conditions No active suicidality,* psychosis, or substance dependence Availability of at least one supportive person for convalescence period Stable living situation Financially self-supportive and responsible Willingness to maintain some contact with referring mental health professional Realistic expectations of SRS and "life after SRS" Viable plan for the future after SRS Availability of postoperative surgical and psychiatric care geographically close to where patient plans to live Psychiatrist is willing to provide written referral letter following the guidelines in the HBIGDA Standards of Care Referring psychiatrist or other mental health professional is comfortable with timing of referral, treatment plan, and patient readiness for major, irreversible surgery |
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Factors suggestive of reassessment or delay in referral: Refusal or inability to follow HBIGDA minimum Standards of Care Short duration of gender identity disorder or lack of diagnosis of gender identity disorder Poor social, familial, and occupational adaptation Active suicidality,a psychosis, or substance dependence No support system Precarious living situation No financial resources View of mental health professionals as merely "gatekeepers" and reluctance to seek assistance Past history of noncompliance with medical regimens Medical or surgical comorbidities that would make SRS risky Unrealistic expectations (fantasies) of SRS No follow-up plan or resources History of genital self-mutilation Borderline personality disorder Poor tolerance of anesthesia Dissociative identity disorder |